week 6: spinal trauma Flashcards
(21 cards)
what is clinically clearing the c-spine
a careful clinical assessment ewiuth a conscious and co-op patient leading to the removal of c-spine collar
history required to clear the c-spine
no history of loss of consciousness GCS 15 + no bev no significant distracting injury no neuro symptoms in limbs no midline tenderness upon palpation of c-spine no pain on gentle active neck movement
if there is doubt, c–spine cannot be cleared, collar must stay on. next step
further imaging
x-rays
CT required
examination of patient with usspected c-spine shd include
full trauma assessment (ABCD) full neuro exam incld -peripheral motor - touch -limb reflexes -cranial nerve evaluation -rectal exam -bulbocavernous reflex assessment (checks sacral nerves)
stable c-spine injjury trearted with
firm cervical collar
unstable c-spine injjuries may require immobilisation in ___ ___ (external fixator, with 4 pins into skull) Some unstable injuries require surgical stabilization including____, ___ ___ . Subluxations and dislocations may require traction for _____ halo application or operative stabilization whilst burst fractures with neurologic deficits may require traction to ____ the spinal canal.
halo vest
fusions, wiring or internal fixation
reduction
decompress
most thoracolumbar spine fractures are due to
motor accidents or falls from a heigh t
if its an elderly patient, it is likely to be ___ ___ ‘wedge’ ____,, which only requires symptomatic treatment
osteoporosis osteoporotic insufficiency
if the injuries stbale (not a burst) of the thoracic spine they may be treated with a brace, why
limits flexion
prevents kyphosis
indications for surgery in spinal fractures
neuro dieficit
unstable injury pattern, substantial loss of vertebral height/displacement
involvement of posterior ligamentous structures
SPINAL SHOCK
physiologic response to injury
complete loss of sensation and motor function and loss of reflexes below the level of injjry
spinal shock resolves within 24hrs t/f
true
depends on severity tho
what signals the end of spinal shock
regain of function of bulbocavernous reflex - reflex contraction of anal sphincter
neurogenic shock occurs after damage to CNS, leads to low bp, bradycardia. how does it occur after spinal injjry
sympathetic outflow from cord (t1 - l2) is shutdown
priapism - painful boner - due to unstoppable para righteousness
how is neurogenic shock treated
iv fluid
central cord syndrome
most common injury pattern
hyperextension injjury in cervical spine with OA
Spinal COrd Injury Without Radiographic Abnormality SCIWORA
in central cord syndome, lower limbs are usually affected tf
false
usually upper
corticospinal (motor) tracrs are more central
t/f sacral sparing is typically present in central cord syndrome
true
anterior cord syndome results in in loss of motor function due to the impact on the corticospinal tracts. However, loss of touch pain and temp is evident, whihc tract is affected by this? the doral columns is unaffected, what do these do
lateral spinothalamic tract
proprioception
vibration sense and light touch
syndome in which there is a loss of dorsal column function (proprioception, light touch and vibration)
posterior cord syndome
rare
brown-sequard syndrome leads to one side of body lossing the sensation of pain, tempt, ligght touch, whilst the other side loses motor functon, vibration, position, deep touch sensation, how tf
hemisection of the cord (usually from prenetrating injury)
ipsilateral paralysis and loss of dorsal column sensation occurs (so opp site of impact loses pain/temp ect)
